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Editorials

Government’s misplaced prevention agenda

BMJ 2018; 363 doi: https://doi.org/10.1136/bmj.k5134 (Published 05 December 2018) Cite this as: BMJ 2018;363:k5134

Re: Government’s misplaced prevention agenda

Since then we've had the publication of NHS England's the Long Term Plan and it neglects to say that the causes of ill health must be addressed by government rather than increasing spend on the results of homelessness/why our daughters are getting more eating disorders/why we as a nation are getting more anxietyand/or depression. The NHS plan is full of addressing increasing problems that would be better tackled by our government at source; these are examples of this plan for the NHS to shut the proverbial stable door:

· 2.14 access to weight management services in primary care for people with a diagnosis of type 2 diabetes or hypertension with a BMI of 30+ (p.37)

· 2.32 We will invest up to £30 million extra on meeting the needs of rough sleepers, to ensure that the parts of England most affected by rough sleeping will have better access to specialist homelessness NHS mental health support (p.42)

· Over 400,000 people in England are problem gamblers and two million people are at risk (p.43)

· 3.25 By 2023/24, at least an additional 345,000 children and young people aged 0-25 will be able to access support via NHS funded mental health services and school or college-based Mental Health Support Teams. (p 50)

· 3.26. Over the next five years, we will also boost investment in children and young people’s eating disorder services… As need continues to rise… (p.50)

· 3.30 NHS England is working closely with Universities UK via the Mental Health in Higher Education programme to build the capability and capacity of universities to improve student welfare services and improve access to mental health services for the student population, including focusing on suicide reduction.. (p. 51)

· 3.50. The latest Global Burden of Disease study shows that the top five causes of early death for the people of England are: heart disease and stroke, cancer, respiratory conditions, dementias, and self-harm (p.56)

· 3.83. Incidence and mortality rates for those with respiratory disease are higher in disadvantaged groups and areas of social deprivation, where there is often higher smoking incidence, exposure to higher levels of air pollution, poor housing conditions and exposure to occupational hazards. Chapter Two detailed the NHS’ contribution to tackling these risk factors.

· 3.90 Stress, anxiety and depression were the leading cause of lost work days in 2017/18. (p. 68)

Tantalisingly, there is a hint that public health be returned to the NHS, but not the leadership to have made the decision, whilst the obesity time-bomb ticks away. (2.4 the Government and the NHS will consider whether there is a stronger role for the NHS in commissioning sexual health services, health visitors, and school nurses)

The lack of leadership in avoiding preventable morbidity is woeful, so for respiratory conditions, one of the five largest global disease burdens, our NHS’s plan is to cut business mileages and fleet air pollutant emissions by 20% by 2023/24 (p.38) 3.83. Incidence and mortality rates for those with respiratory disease are higher in disadvantaged groups and areas of social deprivation, where there is often higher smoking incidence, exposure to higher levels of air pollution, poor housing conditions and exposure to occupational hazards. Chapter Two detailed the NHS’ contribution to tackling these risk factors. At which point I re-read chapter 2 in case I had missed detail on how these risk factors would be addressed, but it was only in targeting smoke-stop in pregnant women and those with mental health problems and reducing pollution from NHS fleet cars. (p.66)

Competing interests: No competing interests

11 January 2019
Helena McKeown
Portfolio GP
Deputy chair of the BMA's Representative Body but this has been submitted in a personal capacity
Salisbury